Article excerpt

The rise, evolution and ambiguous decline of the nervous breakdown in the United States open an interesting window on pervasive anxieties. The concept raises several intriguing historical questions: Why did it originate in the first place, quite early in the century, when other concepts, notably neurasthenia, were already available? (It will become clear that this is one of the hardest issues to resolve.) Why did it decline after the 1960s--the last major popular treatment of the phenomenon, Frank Caprio's How to Avoid a Nervous Breakdown, appeared in 1969? And in fact, how much did it decline, as opposed to losing favor with experts and popularizers? Timing and causation, then, two of the pillars of historical analysis, enter in strongly, along with an effort to trace the evolution of the concept and to determine its meanings during its several-decade heyday.

There is little question that the concept was significant. At various points a great many Americans thought they were suffering a breakdown, or feared one, or knew someone who was involved. A steady stream of articles and books addressed the topic. Popular music paid heed, as in a 1937 recording of "Rehearsin' for a nervous breakdown" by John Kirby's band or a later Rolling Stones number about the "19th nervous breakdown". The term became, and to some degree remains, a standard part of American vocabulary, warning, sometimes humorously, sometimes in testimony of great psychological pain, of an impending clash between external forces and internal capacities. And of course the phenomenon has received historical attention, as part of various studies of American nerves and mental health categories and professions. But few treatments have focused on the phenomenon itself; analysis lags behind that devoted to neurasthenia, which came first but was shorter-lived, though having the advantage of a firmer professional literature. [1] For reasons that will become obvious, nervous breakdown tends to slip through the cracks of medically-oriented social and cultural histories.

This article seeks briefly to explore the historical issues in this rich American artifact. It begins by focusing on the range of functions the nervous breakdown concept served, from its apparent origins around 1901 through its amplifications from the 1930s to the 1960s. Only with the various functions in mind can the problems surrounding origins, popularization and decline be explored--for the concept's sweeping implications help explain why some of the answers to key questions are a bit fuzzy, though suggestive about important concerns in American life. And the concept was, disproportionately, American, particularly before World War II: the term, and related advice literature, spread elsewhere, but even then the points of reference, even the case studies, were drawn from the United States. [2]

The most interesting feature of the nervous breakdown concept, if not at its origins at least quite soon, involves its decidedly ambivalent relationship to professional medicine and psychology. Supported by some professionals, nervous breakdown never broke through to clearly official standing--it did worse, in this regard, than the almost-equally slippery neurasthenia category. But, in an age of medicalization, this ambiguity was clearly part of nervous breakdown's popular appeal. People liked the idea of a disease entity that described symptoms and anxieties they felt, rather than an entity clearly delimited by the burgeoning apparatus of the mental health professionals. They accepted the notion of nervous breakdown often because it was construed as a category that could be handled without professional help, despite the pain it conveyed. Nervous breakdown is not the only disease entity that has been "demedicalized" in the 20th century, [3] but it is an important case, revealing a longstanding need to keep s ome distance from purely professional diagnoses and treatments. Its apparent decline owed something to the greater triumph of medical models, but its persistence shows ongoing ambivalence. …